One response to the
longstanding shortage of mental health providers for children and
adolescents is to expand the connections between child psychiatrists in
academic centers and the primary care physicians who see young patients every
Paradigms for such programs already exist in places such as
Washington state and Massachusetts (Psychiatric News,
February 4). Child psychiatrists are available by phone to consult with
pediatricians, often while the patient is in the office. They also provide
backup services, like face-to-face evaluations of children referred by the
pediatricians or in-service training in psychiatry to pediatricians and their
Yet more could be done to
expand the presence of this model, said Barry Sarvet,
M.D., chief of child and adolescent psychiatry at Baystate
Medical Center in Springfield, Mass.,
an associate clinical professor at
Tufts University School of Medicine, and a leader in the field. Sarvet and colleagues from more than two dozen states have
been working quietly for the last two years to create a national organization
to develop such systems.
The National Network of Child
Psychiatry Access Programs seeks to support the development and sustainability
of state and local programs linking child psychiatrists in academic settings
The organization has four main
goals: advocacy, research collaboration, defining best practices, and providing
technical assistance to members and new programs on matters like funding,
communications systems, and data collection methods to monitor service quality
"By exchanging information, we can avoid reinventing too many
wheels," said Sarvet in an interview with
"There's also a lot of just
plain mutual support, too," added psychiatrist Larry Wissow,
M.D., M.P.H., a professor at the Johns Hopkins Bloomberg School of Public
Health. Hopkins is serving as the temporary home of the nascent organization,
hosting its Web site (see below), while program administrator Irene Tanzman at the Massachusetts Behavioral Health Partnership
in Boston coordinates activities.
"Most of the people involved in starting these programs are doing
it in addition to whatever they usually do, and also potentially departing from
traditional roles for child psychiatry, even from traditional C/L roles," Wissow told Psychiatric News.
The local programs vary given the nature of the populations each
serves and the involvement of local governments and medical institutions.
However, making available the tools and experience of successful programs to
each state group seemed a useful way to increase access to effective mental
health care support for primary care providers.
The concept may be simple, but making it work
in the real world is more complex, said Wissow.
"There are patterns of staffing needs that can be shared rather than discovered
independently, and protocols for managing different types of consultations and
for evaluating their impact."
Another major question is funding. Different mechanisms are often
cobbled together to make a given system work. Often there is a mix of state
monies and insurance payments.
In Massachusetts, for instance, funding comes from the state
budget through the Department of Mental Health, explained Sarvet.
Some program costs are offset by fees charged for face-to-face evaluations of
patients, including Medicaid or commercial insurance payments.
However, most costs lie in the delivery of activities other than
in-person patient evaluations, such as telephone consultation or care
coordination, that are not paid for by insurance and so need some government or
other outside funding, Sarvet explained.
"We are currently seeking
commercial insurance support for the program through various advocacy
strategies," he said.
Some insurers are interested in
the programs because they might reduce costs either by using mental health
resources more efficiently or by shifting some mental health spending to
One unusual funding mechanism is used in Louisiana, where money
from the BP oil spill settlement supports outreach efforts to affected
communities, said Mary Margaret Gleason, M.D., an assistant professor in the
departments of pediatrics and psychiatry and behavioral sciences at Tulane
University School of Medicine.
Many of those communities and the children who live in them had
high rates of poverty and prior trauma from disasters like Hurricane Katrina
even before the oil spill, said Gleason.
The program in Louisiana includes a "warmline"
staffed by two child psychiatrists from Tulane for 15 hours a week who can advise
local pediatricians about managing individual patients. They can also arrange
for face-to-face assessments in New Orleans for complicated cases, for which
the psychiatrists write up detailed evaluations and treatment recommendations.
In addition, they serve more generally as sources of psychiatric information
for participating pediatricians, either over the phone or by delivering
training in the pediatricians' offices.
The National Network of Child
Psychiatry Access Programs has informal connections with the American Academy
of Pediatrics and was planning to seek a formal endorsement from the American
Academy of Child and Adolescent Psychiatry at the academy's annual meeting late
last month, said Sarvet. Ultimately, it may also
explore development of a link with APA.
Information about the National Network of Child
Psychiatry Access Programs is posted at